Combined microsurgical, endovascular, and endoscopic approach to the treatment of a giant vertebrobasilar aneurysm

Aaron R. Plitt, Ankur R. Patel, Cameron M. McDougall, Ashleigh A. Halderman, Samuel L. Barnett, Babu G. Welch

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

BACKGROUND: Dolichoectasia is defined as elongation and dilatation of a blood vessel. In the intracranial circulation, the basilar artery is affected in 80% of cases. These are challenging lesions with an aggressive natural history, and treatment carries a relatively high rate of morbidity and mortality. We describe a case of multimodal treatment including endovascular, open microsurgical, and endoscopic endonasal approach (EEA) for management. OBJECTIVE: To describe the technical nuance of the addition of the EEA for management of posterior circulation dolichoectasia METHODS: A 44-yr-old Hispanic woman with a 2-mo history of progressive headaches, gait disturbance, and lower cranial nerve dysfunction presented with acute neurologic decline. MRI demonstrated a dolichoectatic vertebrobasilar system with a giant 4.5-cm fusiform basilar aneurysm. RESULTS: She underwent concomitant endovascular bilateral vertebral artery sacrifice with suction decompression and trapping by clip ligation distal to the lesion. Postoperatively, she developed symptomatic pontine compression. She was then taken for a transclival EEA for intra-aneurysmal thrombectomy. Thereafter, she made a significant functional recovery. CONCLUSION: The addition of endoscopic reconstruction to the treatment of a dolichoectatic basilar aneurysm is an operative nuance that can be employed in treating these highly morbid lesions. This case describing a multimodal treatment paradigm including EEA reconstruction can serve as an example for the future of treatment select cases of dolichoectasia of the vertebrobasilar complex.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalOperative Neurosurgery
Volume17
Issue number2
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Keywords

  • Aneurysm
  • Endoscopic
  • Giant
  • Thrombosed
  • Vertebrobasilar

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Plitt, A. R., Patel, A. R., McDougall, C. M., Halderman, A. A., Barnett, S. L., & Welch, B. G. (2019). Combined microsurgical, endovascular, and endoscopic approach to the treatment of a giant vertebrobasilar aneurysm. Operative Neurosurgery, 17(2), 149-156. https://doi.org/10.1093/ons/opy341